AIM We investigated the association between obstructive sleep apnoea (OSA) and subclinical cardiac organ damage through a meta-analysis of echocardiographic studies that provided data on left ventricular hypertrophy (LVH), assessed as a categorical or continuous variable. DESIGN The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search English-language articles published from 1 January 2000 to 15 August 2019. Studies were detected by using the following terms: 'obstructive sleep apnea', 'sleep quality', 'sleep disordered breathing', 'cardiac damage', 'left ventricular mass', 'left ventricular hypertrophy', and 'echocardiography'. RESULTS Meta-analysis included 5550 patients with OSA and 2329 non-OSA controls from 39 studies. The prevalence of LVH in the pooled OSA population was 45% (CI 35--55%). Meta-analysis of studies comparing the prevalence of LVH in participants with OSA and controls showed that OSA was associated with an increased risk of LVH (OR = 1.70, CI 1.44-2.00, P < 0.001). LV mass was significantly increased in patients with severe OSA as compared with controls (SMD 0.46 ± 0.08, CI 0.29-0.62, P < 0.001) or with mild OSA. This was not the case for studies comparing patients with unselected or predominantly mild OSA and controls (0.33 ± 0.17, CI -0.01 to 0.67, P = 0.057). CONCLUSION The present meta-analysis expands previous information on the relationship between OSA and echocardiographic LVH, so far based on individual studies. The overall evidence strongly suggests that the likelihood of LVH increases with the severity of OSA, thus exhibiting a continuous relationship.

Obstructive sleep apnoea syndrome and left ventricular hypertrophy: a meta-analysis of echocardiographic studies.

BACKGROUND Whether type 2 diabetes mellitus (T2DM) is independently associated with structural heart abnormalities is controversial because of confounders associated with T2DM. This study aimed to investigate echocardiographic features in patients with newly diagnosed T2DM, exploring changes in cardiac structure and function. MATERIAL AND METHODS This was a retrospective study of new T2DM cases treated at the Second People's Hospital Affiliated to Nanjing Medical University (Changzhou) in 2014-2016. In all, 128 T2DM cases were included (62 hypertensive and 66 non-hypertensive individuals). Controls were selected among individuals who underwent examination at the same department/period. Interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), posterior left ventricular wall thickness (PWTD), left ventricle mass (LVM), end-diastolic thickness of left ventricular posterior wall (Dd), aortic root diameter, left atrial diameter (LAd), left atrial diameter fraction-shortening values, and left ventricular ejection fraction (LVEF) were determined routinely. RESULTS IVST, LVEDD, PWTD, Dd, LAd, and left atrial diameter fraction-shortening values were larger in patients with T2DM (all P 0.05). Multivariable analysis showed that IVST (OR=1.33, 95% CI: 1.01-1.76, P=0.04), LAd (OR=1.16, 95% CI: 1.07-1.25, P<0.001), TGs (OR=1.34, 95% CI: 1.09-1.63, P=0.005), and HDL (OR=1.46, 95% CI: 1.02-2.08, P=0.04) were independently associated with hypertension in patients with T2DM. CONCLUSIONS Patients with newly diagnosed T2DM already display structural heart abnormalities. LAd and IVST are independently associated with hypertension in these patients, probably contributing to increased cardiovascular risk.

/pdf/echocardiographic-changes-in-newly-diagnosed-type-2-diabetes-5740htmeaf.pdf

Echocardiographic Changes in Newly Diagnosed Type 2 Diabetes Mellitus Patients with and without Hypertension.

Background Obesity hypoventilation syndrome (OHS) can be complicated by several cardiovascular conditions. We assessed the prevalence and factors associated with left ventricular diastolic dysfunction (LVDD) in patients with OHS. Methods In this prospective observational study, all consecutive OHS patients referred to the sleep disorders clinic between January 2002 to December 2016 were included (n=113). Demographic data, echocardiography, sleep parameters, arterial blood gases (ABGs), and lung functions were recorded. Results Of 113 patients with OHS who participated, 76 patients (67%) had LVDD. More than two-thirds had grade 1 LVDD. Median body mass index (BMI) was 42.8 kg/m2. Median PaCO2 was 55.8 mmHg. Median apnea hypopnea index (AHI) was 52 (25-38.5). Eighty-four (75.7%) patients were hypertensive, and 60 (54.1%) were diabetic. To minimize the effect of fluctuations in intrathoracic pressure during the obstructive respiratory events on the cardiac function, 38 OHS patients with mild to moderate OSA (AHI <30) were identified. Twenty-seven (71%) had LVDD. When compared to OHS patients without LVDD, patients with LVDD had higher BMI (47.4±6.5 versus 41.5±4.5, P=0.009). Hypertension was more common in OHS patients with LVDD than without LVDD (89.3% versus 54.5%, P=0.03). Correlation analysis revealed that hypertension (r=-0.37, P=0.016) had significant correlations with LVDD. Conclusions Diastolic left ventricular dysfunction is prevalent among OHS patients even in the absence of severe OSA. Hypertension and obesity were significantly more common in patients with LVDD. Assessment of diastolic dysfunction should be included in the initial evaluation of OHS patients to encourage the early institution of therapy.

/pdf/left-ventricular-diastolic-dysfunction-in-patients-with-3x47lxa6ry.pdf

Left ventricular diastolic dysfunction in patients with obesity hypoventilation syndrome

The research objective is the rationale of the theoretical and methodical approach concerning the improvement of regulatory policy as well as the process of distribution of financial investments using the model of the functioning of a recreational sector of the national economy. The methodology of the study includes the use of optimal control theory for the model formation of the functioning of the recreational industry as well as determining the behaviour of regulatory authorities and capabilities to optimize the allocation of investment resources in the recreational sector of the national economy. Results. The issue of equilibration of regulatory policy in the recreational sector of the national economy is actualized, including the question of targeted distribution of state and external financial investments. Also, it is proved that regulatory policy should establish the frameworks that on the one hand, do not allow public authorities to exercise extra influence on the economy of recreation, on the other hand, to keep the behaviour of the recreational business entities within the limits of normal socio-economic activity – on the basis of analysis of the continuum “recreation – work” by means of modified Brennan-Buchanan model. It is revealed that even with the condition of the tax reduction, the situation when the population resting less and works more than in the background of a developed economy is observed. However, according to the optimistic forecast, eventually on condition when the economy is emerging from the shade, we will obtain an official mode of the work in which, while maintaining taxes on proposed more advantageous for the population level, ultimately the ratio leisure and work will be established which is corresponding to the principles of sustainable development. Practical value. On the basis of methodical principles of the theory of optimal control, the model of the functioning of the recreational industry under the conditions of transitivity of the national economy is developed, particularly includes a component of the management of investment resources. As a part of the proposed model, the peculiarities of the functioning of the recreational sector as a combination of recreational enterprises are explored as well as the factors of a behaviour of relevant regulatory authorities are analysed that can be used in the practical activities of recreational business entities. Originality. The paper developed a fundamentally new approach to the analysis of the functioning and management of enterprises in the recreational sector on the basis of economic-mathematical modelling using elements of the optimal control theory. The methodological approach to the rationale of the regulatory policy’s role in establishing optimal points on the continuum “recreation – work” is also improved.

/pdf/regulatory-policy-and-optimization-of-investment-resource-2s7dpmp7pj.pdf

Regulatory policy and optimization of investment resource allocation in the model of functioning of recreation industry

The purpose of the article – to reveal causes and to generalize consequences of the negative impact of globalization processes on the world economy. Methodology. The theoretical and methodological basis of scientific research is the work of well-known scientists in the world who studied issues of globalization development and its influence on separate spheres of economic life, official statistics of the International Monetary Fund and the World Bank on the dynamics of economic development, own research results. In order to achieve the validity and reliability of the research results, the following methods were used: inductive and deductive – for theoretical conclusions; generalization – in studying the content of works of scientists on the impact of globalization processes on the world economy; analytical – during the study of economic consequences of globalization; cause-andeffect – to obtain final conclusions. Results. In this article, causes of the negative influence of globalization processes on the world economy are disclosed. The analysis of economic development of countries in the context of the world economy and, in particular, developed economies, countries of the euro area and developing economies is conducted. Consequences of the negative impact of globalization processes on the world economy are generalized. Practical meaning. The results of this study may be useful to rating agencies, the structure of the World Bank, the Ministry of Ukraine for European and Euro-Atlantic Integration. Value/originality – the reasons and economic consequences of globalization for the world community are specified. Further research should be aimed at preventing the occurrence of crisis phenomena and processes.

/pdf/globalization-and-its-negative-impact-on-the-global-economy-2fiu2x05t8.pdf

Globalization and its negative impact on the global economy

BACKGROUND The aim of this study is to evaluate the correlation of the left ventricular diastolic function and the left ventricular geometry in patients with obstructive sleep apnoea syndrome (OSAS) by echocardiography. METHODS The 181 patients diagnosed with OSAS were divided into the normal geometry group (NG), the concentric remodelling group (CR), the eccentric hypertrophy group (EH) and the concentric hypertrophy group (CH). Pearson correlation analysis and multiple linear regression analysis were performed toward the correlation of the left ventricular diastolic function and the left ventricular geometry. RESULTS The E peak in the EH and CH group was significantly reduced, with significant difference; the E/A, Em, Am and Em/Am was reduced in the order of the CR, EH and CH groups, while E/Em was increased, and the difference was significant. Pearson correlation analysis revealed that the Em/Am showed significant negative correlations with the left ventricular mass index (LVMI) [r = -0.419] and relative wall thickness (RWT) [r = -0.289], while the E/Em was significantly positively correlated with the LVMI (r = 0.638) and RWT [r = 0.328] (p < 0.001). Multiple linear regression analysis revealed that LVMI and RWT had influence on the Em/Am and E/Em (r2 = 0.402, r2 = 0.107, p < 0.001). The left ventricular diastolic dysfunction was the worst in the CH group. CONCLUSIONS There was correlation between the left ventricular diastolic dysfunction and the changes in cardiac geometry.

Correlation of Left Ventricular Diastolic Function and Left Ventricular Geometry in Patients with Obstructive Sleep Apnoea Syndrome.

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Correlation of Left Ventricular Diastolic Function and Left Ventricular Geometry in Patients with Obstructive Sleep Apnoea Syndrome.